Scott L. Replogle, MD (retired)

I have done both upper and lower lid blepharoplasty with local anesthesia and oral sedation alone for years. The key is good local anesthesia but some patients just can't handle any procedure even with good local anesthesia and the next alternative would be IV sedation with monitoring. Since you can't realistically switch from oral sedation to IV sedation during the procedure, what the patient can handle and signs up for is determined before the procedure.

In general, a replacement implant needs to be the same diameter as the previous one. The decrease in size/volume is by going to a lower profile implant. The lowest profile implant is called "low profile". So I would choose the same implant diameter as you have but with a low profile rather than a moderate plus. 

Saline-filled breast implants do not "leak toxins" assuming they were properly filled with sterile saline. They also tend to collapse at least partially rather than "leak". 

It's is important to first understand that breast implants do not actually lift the breast and address ptosis. Larger implants don't lift the breast more. The implant is like a pillow behind the breast and fills it out which can make the breast look lifted but doesn't actually lift it up. 

The way to understand sizing of implants is that for round implants the diameter of the implant needs to match the horizontal width of the breast at the base when upright and arms down (which can easily be measured). Then the forward volume of the implant is chosen by picking a "profile" of implant -- low, medium, moderate plus, or high profile. Unless the breast is unusually wide or narrow, a proper fitting diameter of implant will make the breast look between one cup size (low profile) to two cup sizes (high profile) larger. A medium profile will make the breast look about 1 1/2 cup sizes larger. The patient should consider what size she looks like now and then choose a profile for the increase desired. The number of cc's of the implant is then found by looking up the correct diameter of implant in the chosen profile. 

I would discourage you from having breast implants with a lift at the same time as a tummy tuck. It's too much surgery at the same time and would increase your worries about complications. 

You clearly need a lift as your nipple position is well below your inframammary crease level but you might consider just a lift first and then see if you want more volume. Breast implants are pure pillow volume and do not actually lift the breast. You may have enough volume that you don't need or want an implant after the lift but you can always add it later on once the nipple-areola part of the breast is elevated to the appropriate level.